Jul 12 Advocating for Private-Public Partnerships in the US Economic-Political System

Since the passage and implementation of the Affordable Care Act (ACA), colloquially known as ObamaCare, millions of previously uninsured Americans have been able to obtain and maintain health insurance. Before the passage of the ACA, the number of uninsured Americans continued to rise year after year. The private insurance industry, as a whole, failed to meet an inferred social responsibility of being a sufficient health coverage provider. Government action, in this instance, filled a gap where the private economic forces had failed or forgotten. Driving the development of ACA was a moral imperative of our government leaders to provide healthcare for all [1].This intervention, however, was not a replacement of private industry; in fact, it heavily relied on a private-public partnership to provide insurance. It is through such cooperative legislative efforts that the concept of private-public partnerships can be seen in action. By comparing primarily private and primarily public industries with private-public partnerships, it is possible to highlight points of potential improvement in the current economic-political system.

Government prioritization can change the national policy landscape for generations. This has been most visible through the creation of various government agencies such as the Social Security Administration, National Aeronautics and Space Administration (NASA), and even the Food and Drug Administration (FDA). Government prioritization is often outlined through the formation of a federal budget. When forming a budget proposal, the Democratic Party persistently attacks defense spending, increases some form of taxation, and bolsters national social programs such as Medicare and Medicaid. The Republican Party, in contrast, tends to do the exact opposite, generally lowering tax rates, increasing defense spending, and choosing to replace government action with private action. Both perspectives are ideological opposites, but theoretically share a common goal: to preserve the principles outlined in the Declaration of Independence and US Constitution [2][3].

There also exist economic drivers that are mostly public affairs. An excellent example of this is defense spending. While private entities have historically been largely responsible for manufacturing war materials, public institutions (e.g., one of the five branches of the US military) have been almost entirely responsible for military action. Private, capitalist forces are present in active-field military scenarios (e.g., through private security forces), but the use of this force in a manner akin to enlisted military personnel has been met with reasonable hesitation [4]. These private security forces are not necessarily bound by the same motivations as those who are enlisted: choosing employment in a contracted security company over enlistment in the military represents conflicting motivations between self-promotion and self-sacrifice.

The tremendous amount of defense spending has been reasoned to shield the American people from harm. But if protecting and preserving American lives is our final goal, why would we not invest our time, money, and efforts into another institution, the sole mission of which is to achieve the same protection from harm without the taking of another’s life? The Hippocratic Oath symbolizes the well-intentioned nature of physicians and emphasizes reason, beneficence, modesty, integrity, respect, compassion, and justice, all without the sacrifice of anyone’s life [5]. This is not to undercut the importance of having and properly maintaining a strong military, but is merely an ideological comparison. A truly moral health system does not discriminate or hold prejudice against any individual because of their physical, psychological, spiritual, or financial composition. They only serve to preserve life.

But with so many necessary components, medicine is not foreign to profit-seeking portfolios. Free enterprise has taken the reigns of drug discovery and development. Due to the lack of explicated healthcare policy in the founding documents of the US, modern American society has defaulted to allowing private and commercial forces to dominate health. There is no explicit mention of “health” or “healthcare” in the US Constitution, and only a loose interpretation of “general welfare” can be reasoned to advocate for government involvement in healthcare [5]. This has had dramatic results, both good and bad. The pharmaceutical industry has rolled out an endless supply of drugs to treat chronic conditions such as high blood pressure, high cholesterol, arthritis, depression, acid reflux, and asthma [6]. The supply of hospitals, nursing facilities, long term care facilities, and acute trauma centers has dramatically increased at little or no cost to quality of care [7][8]. These advancements have undoubtedly reduced suffering and improved countless lives, but at the cost of interlocking medicine with money.

With ever-increasing costs, it would be impossible for the US Government to effectively be responsible for the entirety of health. The global pharmaceutical industry, for example, has been successful in commercializing medicine with high profit yields. Recently, however, the free market has forced the industry into a largely unsustainable path. The pharmaceutical industry significantly condensed over the last decade as a result of various acquisitions and buy-outs. While good for controlling competition and broadening one's array of products, this has undoubtedly stunted basic science research and left far less equipped entities (e.g., university or government labs) to perform high cost, low return operations. Antibiotic discovery, for example, has dramatically slowed in recent years, with a staggering 30-year gap between the most recent antibiotic class discovery (in 2015) and the class before it (in 1987) [9].This pattern has resulted in the elimination of many infectious disease research teams, including those focused on antibiotic development. This is a truly daunting reality when one considers the speed with which microbes are developing antibiotic resistance. Because of the seemingly “small market size, […] minimal profit, and rapid [progression] of resistance”, the private industry has no incentive to pursue such an endeavor [10]. The consumer has lost and is left without much hope of a solution in the near future. But this is the precise opportunity for another entity, such as government, to acknowledge a failure and create a solution.

What needs to be done is a blending of ideologies from both ends of the political and economic spectrum: combine the power of government to prioritize neglected or untouched regions of industry with the innovation of the private sector to make these foci sustainable and efficient. This exact scenario played out with the passage of the ACA, specifically identifiable with the creation of an entirely new health sector focused on improving post-acute care. The ACA “fundamentally [transformed] the basic business model of medicine” and enabled entrepreneurs and investors to “underwrite innovative companies specifically designed to profit from the law.” One such company, NaviHealth, was designed “to streamline an enormous but often overlooked corner of the health care market that, many studies conclude, is the most financially wasteful: post-acute care.” Up until its founding, no company that targeted the facilitation of post-acute care existed. NaviHealth has since seen substantial growth and, in 2015, was acquired by Cardinal Health [11][12][13].In this instance, government and private individuals were able to do a greater amount of good when working together [14].

It is critical for the advancement of innovation that people acknowledge that both government and private forces contain an enormous amount of potential to do good for many. By broadening the scope of what resources are available, much more can be accomplished in the way of health development. Private-public partnerships need to be made a cornerstone of our society, especially within health. It is important to keep in mind that neither is incorruptible, however, obligating constant review, regulation, and checks and balances.

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